Healthcare Provider Details

I. General information

NPI: 1265082242
Provider Name (Legal Business Name): ZACHARY PERRY PA-C, CAQ-PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 S HIGHLAND DR STE 250
MILLCREEK UT
84117-4200
US

IV. Provider business mailing address

3080 S 2075 E
SALT LAKE CITY UT
84109-2415
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5009
  • Fax:
Mailing address:
  • Phone: 801-871-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11453778-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: